Rage

I have been in MICU for the past several months as a nurse tech. Since I grad in May the hospital does an interview for new NGs and was offered and accepted a position in MICU as a nurse. We have a 3 month orientation program in place although the unit tries to get you out as soon as possible due to the nursing shortage. My hospital is a trauma level 1 teaching hospital, and MICU gets it's share of SICU overflow. Since I have been there I have participated in 2 swan-ganz placements, observed 3 PICC placements, assisted in 5 CRRT set-ups, observed 3 then assisted in 4 central line placements (jugular, femoral, subclavian) and am considered the "par excellence" in compressions on the 5 codes I have been on (being 6'2 ad 245 pounds doesn't hurt). I have observed and and helped the nurses with patients who had Guillain-Barre, Turner's syndrome, Van Willibrand as well as all of the "normal" stuff as CHF, COPD, ARF, and suicide attempts by ingesting all kinds of strange stuff. I work full time and go to school full time..............and wouldn't change a thing. MICU to me is what envisioned nursing to be, and it has lived up to every expectation. I can exercise my understanding of labs, etiology and treatment of a variety of diseases. And I love change, so with a average stay of 3.8 days per patient this is where I want to be. I know more than some nurses as far as diagnostics and I know al ot less than others, I need to hone my skills area which I can see as being below the level it needs to be, so in whatever free time I have, I practice the procedure in my mind and if I have any questions the nurses are more than willing to help me out. As far as the ICU nurses eating their young syndrome, I have found that when your standing next to them doing compressions as they are pushing the epi, atropine, epi protocol of ACLS to keep their patients alive they are a lot more forgiving of you as a person. ICU isn't about inactive, it's about total active. If you want to spend your time observing and questioning then be prepared to encounter an attitude. But if you understand what your doing there and are offering your skills to the best of your ability and showing that your willing to learn and be part of the team, then you'll do fine. At least that has been my experience.

I have been in MICU for the past several months as a nurse tech. Since I grad in May the hospital does an interview for new NGs and was offered and accepted a position in MICU as a nurse. We have a 3 month orientation program in place although the unit tries to get you out as soon as possible due to the nursing shortage. My hospital is a trauma level 1 teaching hospital, and MICU gets it's share of SICU overflow. Since I have been there I have participated in 2 swan-ganz placements, observed 3 PICC placements, assisted in 5 CRRT set-ups, observed 3 then assisted in 4 central line placements (jugular, femoral, subclavian) and am considered the "par excellence" in compressions on the 5 codes I have been on (being 6'2 ad 245 pounds doesn't hurt). I have observed and and helped the nurses with patients who had Guillain-Barre, Turner's syndrome, Van Willibrand as well as all of the "normal" stuff as CHF, COPD, ARF, and suicide attempts by ingesting all kinds of strange stuff. I work full time and go to school full time..............and wouldn't change a thing. MICU to me is what envisioned nursing to be, and it has lived up to every expectation. I can exercise my understanding of labs, etiology and treatment of a variety of diseases. And I love change, so with a average stay of 3.8 days per patient this is where I want to be. I know more than some nurses as far as diagnostics and I know al ot less than others, I need to hone my skills area which I can see as being below the level it needs to be, so in whatever free time I have, I practice the procedure in my mind and if I have any questions the nurses are more than willing to help me out. As far as the ICU nurses eating their young syndrome, I have found that when your standing next to them doing compressions as they are pushing the epi, atropine, epi protocol of ACLS to keep their patients alive they are a lot more forgiving of you as a person. ICU isn't about inactive, it's about total active. If you want to spend your time observing and questioning then be prepared to encounter an attitude. But if you understand what your doing there and are offering your skills to the best of your ability and showing that your willing to learn and be part of the team, then you'll do fine. At least that has been my experience.

LoriLou.... without a doubt she is overwhelmed. Regardless of med-surg experience or not ICU is known for being a very stressful location. I have no doubt that some new grads should start in med-surg first and then progress into ICU, that said, I also believe that there are some new grads that do fine in ICU. We seem to want to split this question in a nice clean line right down the middle between med-surg or not, and have yet to realize that nothing can be cut so cleanly when dealing with people of different ages and different backgrounds. And I think the reason for that is because we just don't have the information we need about the person or because we just don't have the time to really get to know the person. In your case LoriLou I would recommend to the manager that the new grad be allowed to do "some time" on a step down unit or a med-surg unit. Your frustrations are not only affecting your emotions but is probably spilling over to your co-workers as well. Which isn't fair for you or the person your precepting since your co-workers are forming a lot of their opinions based on your perceptions. I'm going into ICU as a new grad when I pass the boards in June because I have always had high stress jobs and love the pace, call me an idiot if you wish, but I couldn't see myself in any other department. I'm motivated to learn everything I need to learn and am actually pushing my hospital (which is a teaching hospital) to give me all the information they can while I'm a NT in MICU. To me this isn't a party, a disco, or a heebee jeebee (reference to talking heads....lol) it's a privilege. I go in on my own time to take classes I need to take to be better at my job. I treat everyone with respect, and as to the nurses on my unit with admiration for the job they do. If you are precepting any new grad who is less committed then this to doing their job, then do yourself and your co-workers and the new grad a favor and get the new grad off the floor. You are way too valuable to your hospital, your co-workers and yourself to have to deal with a situation like this. Ok.....I'm done.

LoriLou.... without a doubt she is overwhelmed. Regardless of med-surg experience or not ICU is known for being a very stressful location. I have no doubt that some new grads should start in med-surg first and then progress into ICU, that said, I also believe that there are some new grads that do fine in ICU. We seem to want to split this question in a nice clean line right down the middle between med-surg or not, and have yet to realize that nothing can be cut so cleanly when dealing with people of different ages and different backgrounds. And I think the reason for that is because we just don't have the information we need about the person or because we just don't have the time to really get to know the person. In your case LoriLou I would recommend to the manager that the new grad be allowed to do "some time" on a step down unit or a med-surg unit. Your frustrations are not only affecting your emotions but is probably spilling over to your co-workers as well. Which isn't fair for you or the person your precepting since your co-workers are forming a lot of their opinions based on your perceptions. I'm going into ICU as a new grad when I pass the boards in June because I have always had high stress jobs and love the pace, call me an idiot if you wish, but I couldn't see myself in any other department. I'm motivated to learn everything I need to learn and am actually pushing my hospital (which is a teaching hospital) to give me all the information they can while I'm a NT in MICU. To me this isn't a party, a disco, or a heebee jeebee (reference to talking heads....lol) it's a privilege. I go in on my own time to take classes I need to take to be better at my job. I treat everyone with respect, and as to the nurses on my unit with admiration for the job they do. If you are precepting any new grad who is less committed then this to doing their job, then do yourself and your co-workers and the new grad a favor and get the new grad off the floor. You are way too valuable to your hospital, your co-workers and yourself to have to deal with a situation like this. Ok.....I'm done.

Personally I think that ANY manager that would give you the option of a NT or an RN is being ridiculous. If that were the case then I'd be very concerned about their budgets because they have to be running very tight and actually too tight. Which then begs the question of whether they are understaffed as it is and what the patient/nurse ratios are. Does your facility have sitters as well? If not then what are your fall ratios? TPC, VS q1 and turns q2 are minimum requirements at my hospital and although not completely handled by the NT they do take a huge load off of the RN with care, procedures, and transport......But then you have to remember that to be in ICU as a NT in my hospital you have to be in the upper 1/3 of your class and in the last semester of NS school so your basically finishing up and waiting to take your boards. Step down units don't have the same strict requirements of their CNAs or NTs........ But personally I think if I was doing a dressing change for a chest tube, or securing a patient's vent and needed another piece of tape then it would be nice to have someone there to help without pulling another RN away from her patient........but then that's just me.

I'm in my last semester at NS and just got a PCT job in MCC at a level 1 hospital. Including myself, there will be 3 total PCT's on a 30 bed floor. This hospital will hire new grads into ICU only if they PCT on the floor first. This is pretty much a pilot program since PCT's in ICU have only been going on for about 4 months now and they will only hire students which are in the top 1/3 of their class and want to go into ICU nursing upon graduating. So since I'm motivated to be there, interested in learning everything I can about it, and want as much experience as I can to be a good ICU nurse its to both of our benefit. Since my college has a specific "critical care" class most of my clinicals were at this hospital as well so I knew most of the nurses and the manager.

Thank you for the information. It was that level of specifity that I was looking for. The college I attend requires a physical and a background check via the FBI before you can even attend the nursing program. I'm not sure about the amount of hours our clinicals equate to but I do know most school have 2 med-surg classes and we have a med-surg and a critical care. It is the critical care area that I want to go into. I'll check with the schools here and see what they require for graduation to determine where my schooling falls regarding requirements. It's interesting that there are so many differences in requirement for nurses with licenses, when both countries practise the same medicine......... oh well sie la vie

Thank you for your information, from what I understand the providences have their own aspects of nursing requirements and for testing just like the states do. Which is the reason I mentioned British Columbia in the beginning. I have already gone to the CRNBC website to determine their requirements and I seem to have the largest percentage of it. But of course that in itself doesn't answer my questions either. Again thank you for your background story, but I'm not sure where it applies to the question I asked.

First of all, hello to all that reads this. [background] To begin, my fiancee lives on Vancouver Island and her mother (73 yo) lives in the same house. Since I graduate in May 2008 and want to pursue a advanced degree as a CRNA I need to have 2 years of ICU experience. Because my fiancee and I are getting married after I graduate and we need to be in close proximity to her mother (just in case anything goes wrong) I will be moving either to Washington State or Canada. I have spoken to hospitals in both Bremerton, Washington and the VIHA in Victoria (I know VI very well as my fiancee and I have been engaged for the past 4 years and I have travelled there many times). Both hospitals want to meet me when I go there for the Christmas holidays. I will be working as a Nurse Tech in ICU from January to May and will have not only my RN when I graduate but fully expect to have my ACLS, PALS as well. I am on the Sigma Theta Tau nurse honor roll and will have 8 letters of recommendations from the Deans, Professors and the ICU preceptors. The human resource person I spoke to at VIHA was talking about sponsorship and applying for "landed immigrant" status in order to work in Canada. I have no problem taking any test they require nor of seeking any qualifications they want. Moving to Canada would make more sense in more than one regard. I have already spoken to the CRNA school I want to attend and they were more than happy to take the ICU experience earned in Canada. I want to also pursue the CCRN certification while I am in Canada and they will be more than happy to take the 1500 bedside hours earned in Canada as well (ultimately, I want to have dual citizenship). [The question] Does anyone have any experience with the licensure process in BC? Does anyone have any reasonable guess as to what my chances are of actually getting a position in ICU at Jubliee Hospital in Victoria with my background? Obviously I do my best to be prepared for any situation, so any information you would be willing to provide would be greatly appreciated. Kindest regards, Joe

Check with the local hospitals, most of the ones I have dealt with will hire you as a CNA after your first semester in a BSN program if that is your desire. But I agree with Queen, if money is the pressing issue then don't make matters worse by adding to the headache.

Interesting since this government site http://www.nh.gov/nhes/elmi/licertoccs/nursarnp.htm defines ARNP as: Description An Advanced Registered Nurse Practitioner (ARNP) is a Registered Nurse (RN) qualified to function independently. May perform physical examinations and diagnostic tests, develop and carry out treatment programs, or counsel patients. May prescribe medications noted in formulary. Specialty areas include: Nurse Midwife, Pediatric Nurse Practitioner, Family Nurse Practitioner, Ob/Gyn Nurse Practitioner, Adult Nurse Practitioner, Geriatric Nurse Practitioner, School Nurse Practitioner, Psychiatric/Mental Health Specialist, Neonatal Nurse Practitioner, Emergency Room/Trauma Nurse Practitioner, and Certified Registered Nurse Anesthetist. but then what do I know..........

Here is the link to Barry University: http://www.barry.edu/anesthesiology/curriculum.htm Here is the information:Upon successful completion of the curriculum, graduates are eligible to sit for the National Certification Examination for nurse anesthetists and are eligible for licensure as an advanced practice professional nurse by the State Boards of Nursing in the state in which the graduate seeks to practice. Upon completion of certification and licensure requirements, graduates attain the professional credentials of Certified Registered Nurse Anesthetist (CRNA) and Advanced Registered Nurse Practitioner (ARNP in Florida or similar terminology used in other states). So Eric to answer the question you asked I'd say a ARNP

Thomask, IGg metabolizes to half-life in 27-36 days with a clearance rate between 2.988 and 3.648 mg/kg/day http://www.springerlink.com/content/h35u2t521451814k/

I know that in Florida if you have a CRNA you can sit for the NP exam license. No more schooling required.

As a soon to graduate student I would like to suggest that you find the area of nursing you want to practise and mention it to any of your instructors. By doing so it's possible that they will give you the clinical sites that would best fit your desires.

Tried the pm thing and it doesn't work............so CRNA2007 if you could pm me then I'll be glad to receive a copy as well, thanks in advance

Thanks Jen, I was pm'ed and received a site called CRNAstuff.com that had what I was looking for. But I appreciate your response.

Before I tell you my idea, let me explain why I came up with the idea. I'm a senior in NS and grad in May. We have been given etiologies of all the major disease and disorders, we have been taught assessments, and normals. We have been taught about drugs and their pharmacodynamics and pharmacokinetics. So I feel pretty comfortable with my knowledge base so far and just need some experience to go along with it. Since I'm planning on going CRNA eventually, I really looked forward to my ICU rotations. But there was one problem....... Even though I knew about the drugs and their actions on the body, I didn't know how to set the infusion pumps, neither baxter, plum or PCA. I'm sure there are others as well that I still have no idea even exist. So here is my idea, since I also program computers (total geek here) I want to create a simulation program that will let students learn how to set the pumps and what to expect when they are set. I'd program in any alarms, lights, and digital readouts so it simulates the pumps as close as possible. By doing this, when students come to the units they will have at least a decent idea what to do when they get there. It will make them more confident in their "skills" and it will give the preceptors more freedom after verifying that the student does indeed know how to run the pumps. How you can help: I need to get some good hi-res pictures of the front of the pumps, not the sides nor the backs. But a good front on picture of the pumps. Those pictures will be the underlay that I will place the controls on, so it needs to be as good of a picture as possible. The brochures they send out aren't hi-res enough. If you wish to help with this endeavor then just pm me for my email address so you will have a place to send the pictures to.................. Hopefully if this turns out as expected then, it may be used during ICU indoctrination as well.

Sorry Greg I should have said opiate..........I just got off a 12hr clinical rotation in ICU when I responded, where I had to attend to a girl that was mauled by 2 dogs, unfortunately we lost her......should have given it more thought. RNNJ I didn't mean to appear terse but as you noted I am a focused person, classical type "A" or better known as "OFS" (old fart) syndrome. And of course I appreciate your suggestion, but it does seem that soooooo many time (especially in the CRNA section) that responses have nothing to do with the original post. My current library consist of : How to Survive in Anaesthesia - Guide for Trainees Handbook of Anesthesiology (2004-2005) Cambridge University Press The Anaesthesia Science Analgesic v4-2002 (Theraputic Guidelines - Pain Management) Anaesthesia for the High Risk Patient Analgesia - C. Stein Textbook of Neuroanaesthesia and Critical Care Anaesthetic and Obstetric Mgmt of High-Risk Pregnancy 3rd ed Clinical Anesthesiology (Lange's) 3rd ed Clinical Anesthesia 4th ed - P. Barash Textbook of Anaesthesia 4th ed. - A. Aitkenhead, D. Rowbotham, G. Smith So yes I have the information at hand but would have to develop the cards independently...........and of course I have the programs that would allow me to do that as well (having dealt with computers since the Atari 400 in 1980). But I was looking for the "easy" way out by trying to find cards similar to the "Nurse's Med Deck" by F.A. Davis (which I also have, 10th edition) and create a flip binder to quiz myself on during my "off" times like during Thanksgiving. Not being married and having no children allows me plenty of time to acquire knowledge during the holidays when I don't have to worry about holidays and family gatherings................yes it's a sad life but its the cards I was dealt so I make the best of it.

RNNJ, I appreciate what your saying. And I am focusing on my ICU experience which is why I am also preparing to take the CCRN certification, so that I will be ready when my 1500 bedside hours are up. But at the same time I know where my weaknesses are, and they are the meds. So I have boned up on my betas, calcium channel blockers, my osmotics and loops, morphine of course is a sedative, my emetics, antibiotics, etc .........all in the focus of being in ICU. But of course that wasn't my question..............

iiright.......where is the thread, someone stole the thread................ break out the torches again.

As the villagers gather with torches shouting words of unfathomable blasphemy "The monster lives"

Hey Guys, I just completed a rotation in OR with a great CRNA named Mark who really went into the teaching mode and showed me some amazing aspects of Anesthesia. Since CRNA is and has been my focus since I started NS, his tutorage was deeply appreciated. But I digress........ There was a SRNA there as well, who had a deck of pharm cards on neuromuscular blocks, Opiates, Sedation meds, etc.......he said he got the cards on line (came in a zip file I think and had to print them) for about $17.00 and was going to send me the URL. Well, so far he hasn't and I was wondering if anyone here has heard of it or knows the URL to the site. I'm asking because I've rotated out of that Hospital and don't have access to him anymore. Even though I grad NS school next semester, I'm studying for my CCRN for ICU and want to get a jump on the pharmacokinetics, and pharmacodynamics of anesthesia meds..........let's just say I'm a focused dood........................lol

I went through ob/gyn clinical last semester. I had an advantage over you though, I'm 52 years old, and most women don't mind "older guys" in the room. The problem isn't so much with the staff or the docs but with the patient's not wanting "men" in the room which I can understand. Of the 6 other males in the class I'm the only one the patient's would allow in the rooms. I am thankful I witnessed a lady partsl birth and 2 c-sections. Then I was lucky enough to have one of the same patients for postpartum care. It made a huge difference. Bottom line is that the professors understand the situation since you aren't the first male to go that rotation. Tell them about your concerns and I'm sure they will be more than understanding

Hmmmmm the biggest problem I have is being called "doctor" by the patients. I correct them by simply stating that I'm a nurse and they still call me doctor..............and I'm still in NS I have never had a problem with the nursing staff at clinicals considering me as "one of them" especially when they need to do a turn on a morbidly obese patient (I'm 6'2" and 235......he he he)